Intrinsic Tongue Muscle Tumors

Intrinsic tongue muscle tumors are abnormal growths (neoplasms) that arise within the four paired intrinsic muscles of the tongue—superior longitudinal, inferior longitudinal, transverse, and vertical. These tumors can be benign (non‑cancerous) or malignant (cancerous), and they alter tongue shape and function by uncontrolled proliferation of muscle cells or adjacent tissues .

• Benign examples: granular cell tumor, schwannoma, hemangioma, lipoma.

• Malignant examples: rhabdomyosarcoma, squamous cell carcinoma involving muscle invasion .

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Anatomy of Intrinsic Tongue Muscles

The intrinsic muscles both originate and insert within the tongue, altering its shape and fine movements.

1. Structure & Location

• Four paired muscles lying entirely within the tongue substance.

• Deep to the mucosal layer on the dorsal and ventral surfaces .

2. Origin & Insertion

• Superior Longitudinal: from the median fibrous septum and epiglottis to the lateral margins and apex.

• Inferior Longitudinal: from root of the tongue to the apex’s ventral surface.

• Transverse: from the median fibrous septum outward to the lateral mucosa.

• Vertical: from the dorsal mucosa down to the ventral mucosa .

3. Blood Supply

• Artery: branches of the lingual artery (dorsal and deep lingual branches).

• Vein: deep lingual vein draining into the internal jugular system .

4. Nerve Supply

• Motor: hypoglossal nerve (CN XII) for all intrinsic muscles.

• Sensory: lingual nerve (general sensation) and chorda tympani (taste) for mucosa only .

5. Functions ( Key Actions)

1. Shorten and thicken the tongue (superior + inferior longitudinal)

2. Elongate and narrow the tongue (transverse)

3. Flatten and broaden the tongue (vertical)

4. Curl the tip upward (superior longitudinal)

5. Curl the tip downward (inferior longitudinal)

6. Modulate tongue shape for speech, swallowing, and mastication .

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Tumor Types

• Benign Tumors:

  • Lipoma, hemangioma, lymphangioma, schwannoma, granular cell tumor, leiomyoma, neurofibroma, hamartoma.

• Malignant Tumors:

  • Rhabdomyosarcoma (embryonal, alveolar), squamous cell carcinoma with muscle invasion, leiomyosarcoma, fibrosarcoma, malignant granular cell tumor .

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Causes & Risk Factors

1. Tobacco smoking – cancer‑causing chemicals damage muscle and mucosa

2. Alcohol use – synergistic with tobacco in mutagenesis

3. Human papillomavirus (HPV) infection – high‑risk strains induce oncogenes

4. Age over 50 years – cumulative exposure to carcinogens

5. Male gender – higher tobacco/alcohol exposure historically

6. Betel quid-chewing – associated with oral carcinogenesis

7. Genetic syndromes (Li‐Fraumeni, Beckwith–Wiedemann) – predispose to rhabdomyosarcoma

8. Neurofibromatosis type 1 – risk for neurogenic tumors

9. Costello syndrome – rare muscle‑tumor risk

10. Prior radiation therapy to head/neck – DNA damage in muscle cells

11. Chronic mechanical irritation (poor‑fitting dentures)

12. Poor oral hygiene – chronic inflammation

13. Diet low in fruits/vegetables – reduced antioxidant protection

14. Immunosuppression (HIV, transplant recipients)

15. Chronic candidiasis – chronic mucosal inflammation

16. Occupational exposures (wood dust, formaldehyde)

17. Ultraviolet light (for lip tumors)

18. Family history of head & neck cancers

19. Obesity – systemic inflammatory milieu

20. Alcoholic mouthwash overuse – mucosal irritation

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Symptoms

1. Persistent lump or swelling in tongue

2. Non‑healing ulcer on tongue surface

3. Pain or tenderness in tongue

4. Difficulty speaking (dysarthria)

5. Trouble swallowing (dysphagia)

6. Numbness of tongue or mouth lining

7. Red or white patches (erythroplakia, leukoplakia)

8. Bleeding from tongue lesion

9. Weight loss from eating difficulties

10. Ear pain (referred otalgia)

11. Jaw stiffness or trismus

12. Ulceration crossing midline

13. Pain radiating to chin or neck

14. Hoarseness if base of tongue involved

15. Excess salivation (sialorrhea)

16. Dyspnea if large mass

17. Tongue fixation to floor of mouth

18. Foul odor from necrotic tissue

19. Visible muscle invasion on inspection

20. Regional lymph node enlargement

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Diagnostic Tests

1. Clinical oral examination

2. Incisional biopsy for histology

3. Brush cytology

4. Fine‑needle aspiration of lymph nodes

5. MRI – superior soft‑tissue contrast

6. CT scan – bone invasion assessment

7. Ultrasound – superficial mass evaluation

8. PET‑CT – metabolic activity & metastases

9. Endoscopic evaluation (base of tongue)

10. Panendoscopy – multi‑site inspection

11. Chest X‑ray – lung metastases

12. Blood tests (CBC, liver/renal function)

13. Tumor markers (e.g., SCC antigen)

14. Bone scan – distant skeletal spread

15. Panoramic dental X‑ray – mandibular invasion

16. Genetic testing in pediatric RMS (PAX‑FOXO1)

17. Ultrasound‑guided core biopsy

18. Margin mapping with frozen section

19. Sentinel lymph node biopsy

20. Excisional biopsy of small lesions

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Non‑Pharmacological Treatments

1. Wide local excision (surgery)

2. Partial glossectomy

3. Hemiglossectomy

4. Total glossectomy

5. Neck dissection for nodal disease

6. Sentinel lymph node biopsy

7. Transoral robotic surgery (TORS)

8. Laser microsurgery

9. Mohs micrographic surgery

10. External beam radiotherapy

11. Brachytherapy

12. Photodynamic therapy

13. Cryotherapy

14. Radiofrequency ablation

15. Hyperthermia therapy

16. Speech and language therapy

17. Swallowing rehabilitation

18. Nutritional counseling & feeding tube

19. Occupational therapy

20. Physical therapy (neck/jaw exercises)

21. Oral hygiene regimens

22. Mouth rinses (chlorhexidine)

23. Hyperbaric oxygen therapy

24. Acupuncture

25. Massage therapy

26. Psychosocial support groups

27. Oral prosthetic rehabilitation

28. Mindfulness & relaxation techniques

29. Yoga and gentle stretching

30. Palliative care services

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Drugs

1. Cisplatin Cancer Info Resources

2. Carboplatin Cancer Info Resources

3. 5‑Fluorouracil (5‑FU) Cancer Info Resources

4. Docetaxel Cancer Info Resources

5. Paclitaxel

6. Methotrexate

7. Bleomycin

8. Vincristine

9. Cyclophosphamide

10. Ifosfamide

11. Doxorubicin

12. Cetuximab (EGFR inhibitor) Cancer Info Resources

13. Panitumumab

14. Nivolumab (PD‑1 inhibitor) Cancer Research UK

15. Pembrolizumab (PD‑1 inhibitor) Cancer Research UK

16. Durvalumab (PD‑L1 inhibitor)

17. Atezolizumab (PD‑L1 inhibitor)

18. Erlotinib (EGFR TKI)

19. Gefitinib (EGFR TKI)

20. Sunitinib (multi‑TKI)

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Surgeries

1. Wide local excision

2. Partial glossectomy

3. Hemiglossectomy

4. Total glossectomy

5. Transoral robotic surgery

6. Laser microsurgery

7. Mohs micrographic surgery

8. Neck dissection

9. Sentinel lymph node biopsy

10. Microvascular free flap reconstruction

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Prevention Strategies

1. Quit tobacco

2. Limit alcohol

3. HPV vaccination

4. Maintain good oral hygiene

5. Regular dental check‑ups

6. Healthy diet rich in fruits/vegetables

7. Avoid betel quid chewing

8. Protect lips from UV exposure

9. Manage immunosuppression

10. Self‑examination of oral cavity

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When to See a Doctor

Seek medical evaluation if you notice any of the following persisting more than two weeks:

• A lump, ulcer, or patch on the tongue

• Persistent pain, bleeding, or numbness

• Difficulty swallowing, speaking, or breathing

• Unexplained weight loss .

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Frequently Asked Questions

1. What is the prognosis of intrinsic tongue muscle tumor?
   Depends on tumor type, size, stage, and treatment; early-stage benign tumors have excellent outcomes, while advanced malignant tumors require multimodal therapy .

2. Can benign muscle tumors become cancerous?
   Rarely; most benign tumors remain non‑invasive, but any growth that changes warrants re‑evaluation .

3. How is rhabdomyosarcoma of the tongue treated in children?
   Multimodal: surgery, chemotherapy (VAC regimen), and radiotherapy under pediatric oncology protocols .

4. Is radiation therapy necessary after surgery?
   Often recommended for malignant tumors with close margins or lymph node involvement to reduce recurrence .

5. What are common side effects of chemotherapy?
   Nausea, fatigue, hair loss, mucositis, myelosuppression; supportive care can mitigate these Cancer Info Resources.

6. How often should I have follow‑up exams?
   Typically every 1–3 months in the first two years, then 3–6 months through year five .

7. Can I speak normally after partial glossectomy?
   With speech therapy, many patients regain intelligible speech, though accent and strength may vary .

8. Are new targeted therapies available?
   Yes—EGFR inhibitors (cetuximab) and immune checkpoint inhibitors (pembrolizumab, nivolumab) show promise Cancer Info Resources.

9. Can intrinsic muscle tumors recur?
   Malignant tumors have a higher recurrence risk; close monitoring is essential .

10. Is swallowing therapy helpful?
    Yes—early involvement of a speech‑language pathologist improves long‑term swallowing function .

11. What imaging is best for small tongue tumors?
    MRI offers superior soft‑tissue contrast to detect early muscle invasion .

12. Can non‑surgical treatments cure early tumors?
    Radiotherapy alone may suffice for small, well‑differentiated lesions in select cases .

13. How do I reduce the risk of oral cancer?
    Avoid tobacco/alcohol, vaccinate against HPV, maintain oral hygiene, and have regular dental exams .

14. What role does genetics play?
    Rare syndromes (e.g., Li–Fraumeni) increase rhabdomyosarcoma risk; genetic counseling may be indicated .

15. When is palliative care appropriate?
    For advanced, recurrent, or metastatic tumors not amenable to curative treatment, focusing on quality of life and symptom control .

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 22, 2025.

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